HB 2552, which requires an act of the Legislature to expand Medicaid through the Affordable Care Act, has been signed by Gov. Sam Brownback, his office announced Friday.

The bill was originally created to require prompt payment from KanCare providers. It was amended on the Senate floor to include legislative approval of a Medicaid expansion.

“It doesn’t take a position on whether or not Medicaid expansion under the Affordable Care Act should take place in Kansas. But what it does say is it should be up to the people’s elected representatives to make that decision,” said Rep. John Rubin, R-Shawnee, who carried the amended bill on the House floor.

Rubin agreed that since the Legislature is already finished with its regular session, the issue will not come up again until 2015. “You certainly could say it’s a pause between now and next January,” he said.

Expanding Medicaid would give coverage to about 78,000 uninsured Kansans. The expansion would be covered by federal dollars for the first years, but would eventually require state dollars for part of the cost.

Brownback has repeatedly said he has not made a final decision on expansion, but that he would not support it until problems with the Affordable Care Act are addressed. Signing the bill puts the decision in the hands of lawmakers.

In a White House briefing Thursday, President Obama criticized Republican state officials for not expanding Medicaid for “no other reason than political spite.”

“We’ve got 5 million people who could be having health insurance right now at no cost to these states. Zero cost to these states,” Obama said.

Rubin said he opposes expansion as a fiscal conservative. He noted that Kansas was one of 26 states that sued the federal government over the Affordable Care Act.

“The one part on that lawsuit that we prevailed on – and we spent a lot of taxpayers’ money to prevail on that point – was that the federal government could not force us in Kansas, or any other states, with threats of removing all federal Medicaid funding, could not force us to expand,” Rubin said.

He said it would be a waste of the state’s resources already spent on the issue to simply expand with legislative debate.

Controversial addition

Rep. Jim Ward, D-Wichita, was harshly critical of the governor’s decision to sign the bill.

Ward and Sen. Jim Denning, R-Overland Park, both of whom sit on the KanCare oversight committee, originally recommended a prompt payment law to the Legislature.

But after the provision to indefinitely halt Medicaid expansion was added to the bill, Ward became one of its strongest opponents.

“That bill is what I think is endemic with this legislative process under this governor, and this speaker and Senate president. There was no hearing. There were no opportunities for people who have a stake in Medicaid expansion to come in and talk about it,” Ward said.

“There was no great debate about the merits. It was snuck in on a late night in the Senate and presented to the House as a take-it-or-leave-it proposition,” Ward said.

Ward said expansion of Medicaid is an important issue to a large number of Kansans beyond the uninsured who stand to benefit. He said medical professionals and other stakeholders were denied an opportunity to speak on the issue. The Legislature held no hearings on Medicaid this year even though bills were introduced to enable expansion.

Katrina McGivern, spokeswoman for the Kansas Association for the Medically Underserved, said legislative approval adds an extra step but that her organization is prepared to work on educating legislators about the benefits of expansion.

“There’s just so many people out there that are suffering, and in poor health, and don’t have the access to the health care that they need and have a right to. And this would allow them to get the care they need and it also would provide a benefit as far as resources go,” she said.

Decision shifts to legislators

Ward said that by signing the bill, Brownback was abdicating his responsibility to decide on the issue. Because there are no state funds needed for the first three years, the governor could have approved expansion on his own.

“I have a concern about this governor ducking the tough issues. … Very rarely do I see him stand up and try to lead on the controversial issues of the day,” he said.

Brownback’s campaign manager, Mark Dugan, disputed that notion.

“Kansans know where Sam Brownback stands on every major issue facing Kansas,” Dugan said in a phone call.

He said that the governor has consistently said that legislative approval should be required to expand Medicaid.

“The constitution requires the Legislature weigh in on issues of spending. Obamacare expansion in Kansas would cost a billion dollars over 10 years. It is vital the Legislature have the opportunity to weigh in on these issues,” Dugan said, referencing a 2013 study by the Kansas Department of Health and Environment on the potential cost of expanded Medicaid after full federal funding stops.

The signing of the bill essentially means that if a Democrat were elected governor this fall, Medicaid expansion won’t be a sure thing.

Rubin seemed to acknowledge that when explaining why he thinks the Legislature is better equipped than the governor’s office to make the decision.

“Gov. Brownback’s not always going to be the governor. It’s my fervent hope he’s going to be the governor for four more years after this one, but he may or may not be,” Rubin said. “And even with the governor’s best intentions, the widest diversity of information and opinion on this issue I think can be gleaned from 125 representatives and 40 senators each answering to their own constituency.”

Paul Davis, the likely Democratic candidate for governor, said that regardless of who is governor, he is “hopeful that legislators will open a dialogue with health care professionals about the needs of Kansas communities and how Medicaid Expansion could impact local hospitals – but more importantly how it impacts patients.”